ingest cdrApp 2017-08-15T21:30:29.815Z d91e81c8-5a8a-4e8a-976c-cad4e396e5ee modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T21:31:11.948Z Setting exclusive relation modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T21:31:12.556Z Setting exclusive relation addDatastream MD_TECHNICAL fedoraAdmin 2017-08-15T21:31:13.192Z Adding technical metadata derived by FITS modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T21:31:31.157Z Setting exclusive relation addDatastream MD_FULL_TEXT fedoraAdmin 2017-08-15T21:31:32.623Z Adding full text metadata extracted by Apache Tika modifyDatastreamByValue RELS-EXT fedoraAdmin 2017-08-15T21:31:50.479Z Setting exclusive relation modifyDatastreamByValue RELS-EXT cdrApp 2017-08-22T13:58:13.525Z Setting exclusive relation modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-01-25T16:32:05.736Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-01-27T16:16:55.868Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-03-14T13:55:24.217Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-05-18T16:28:46.396Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-11T12:32:02.034Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-07-18T08:22:58.041Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-08-17T14:18:44.104Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-08-21T17:11:56.808Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-09-27T17:20:28.802Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-12T08:28:40.344Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2018-10-17T13:45:55.825Z modifyDatastreamByValue MD_DESCRIPTIVE cdrApp 2019-03-21T18:32:28.495Z Vidya Venkataramanan Author Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. Summer 2017 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. Summer 2017 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. Summer 2017 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017-08 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 University of North Carolina at Chapel Hill Degree granting institution Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 University of North Carolina at Chapel Hill Degree granting institution Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change; case study; implementation; qualitative; sanitation; systematic review eng Doctor of Philosophy Dissertation Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 University of North Carolina at Chapel Hill Degree granting institution Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation University of North Carolina at Chapel Hill Graduate School Degree granting institution Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health One Size Does Not Fit All: Analyzing Variations in the Implementation of Community-Led Total Sanitation An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change, case study, implementation, qualitative, sanitation, systematic review eng Doctor of Philosophy Dissertation Environmental Sciences and Engineering Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 University of North Carolina at Chapel Hill Degree granting institution Vidya Venkataramanan Creator Department of Environmental Sciences and Engineering Gillings School of Global Public Health An estimated 946 million people in the world practiced open defecation in 2015, 90% of whom lived in rural areas Poor sanitation poses a substantive environmental health and development challenge. Community-led total sanitation (CLTS) has become the predominant behavior change approach to improve sanitation in rural communities in lower income countries. It is acknowledged as flexible and context-specific, but a systematic analysis of its implementation was lacking. The purpose of this dissertation was to study the context and process of CLTS implementation in various settings to identify factors that influence implementation and thereby, outcomes of the intervention. I conducted a systematic literature review of the available evidence on CLTS to document adaptations, effectiveness on sanitation and health outcomes, and quality of evidence. I found that the diffusion of CLTS worldwide was backed by minimal rigorous evidence of its effectiveness. I also found that, although CLTS adaptations had been widely documented by practitioners, no study had characterized adaptations to understand how best to structure programs to improve their effectiveness in various settings. Therefore, I analyzed adaptations through qualitative case studies of CLTS implementation in seven countries. Data collection included interviews with 293 respondents, and 34 community visits. Rather than being a “community-led” approach, I found that CLTS can be categorized into three broad implementation modalities: NGO-led CLTS, government-led CLTS, and mixed leadership of CLTS. I applied an implementation research framework to these case studies to systematically analyze context and process factors that influence CLTS implementation. This framework serves as both a hypothesis generating tool for researchers and a diagnostic tool for practitioners. My work suggests that an honest exploration and understanding of CLTS implementation is vital to identify improvements, to understand the potential of the approach to achieve desired outcomes, and to recognize ways in which it can be implemented to improve rural sanitation in different contexts and settings. By building a stronger evidence base of mixed methods, and offering concrete tools and recommendations for practitioners and policymakers, the aim is to bridge the gaps between academic implementation theory, ambitious policymaking, and dynamic CLTS practice to improve sanitation programs. 2017 Public health Public policy Environmental studies behavior change; case study; implementation; qualitative; sanitation; systematic review eng Doctor of Philosophy Dissertation Jamie Bartram Thesis advisor Pete Kolsky Thesis advisor Margaret Bentley Thesis advisor Jacqueline MacDonald Gibson Thesis advisor Clarissa Brocklehurst Thesis advisor text 2017-08 University of North Carolina at Chapel Hill Degree granting institution Venkataramanan_unc_0153D_17289.pdf uuid:06324228-d024-4222-b8c2-64a9ed9983f4 proquest 2017-07-20T19:40:32Z 2019-08-15T00:00:00 application/pdf 3220664 yes